Ultrasound guided aspiration biopsy for pulmonary tuberculosis with unusual radiographic appearances.

BACKGROUND: Pulmonary tuberculosis can produce unusual radiographic appearances and negative results of sputum and bronchoscopic examinations are common. This study assessed the value of ultrasound guided aspiration biopsy in the diagnosis of pulmonary tuberculosis with unusual radiographic appearances. METHODS: Thirteen patients, ultimately diagnosed as having tuberculosis, underwent a chest ultrasonographic examination between June 1984 and August 1991. All had sputum available for examination and nine were also examined by bronchoscopy. Ten patients who had a negative sputum smear and negative bronchoscopic brushing smears underwent ultrasound guided aspiration or biopsy. Percutaneous aspiration was performed with a 22 gauge needle. If the smear did not reveal acid fast bacilli, a biopsy sample was taken with a 16 gauge Tru-cut needle to obtain a histological diagnosis. RESULTS: The ultrasonographic examination delineated the more complex nature of the lesions better than the chest radiograph. Ultrasound guided aspiration biopsy provided the diagnosis in nine of 10 patients, while the sputum smear and culture provided diagnosis in five of 13, and bronchoscopy in four of nine. In terms of rapid diagnosis, ultrasound guided aspiration biopsy gave the diagnosis in eight of 10 cases. No patient developed a major complication. CONCLUSION: Ultrasonography can direct the needle to the most suitable part of a lesion to obtain the relevant specimens. The diagnostic yield is high and the procedure is relatively safe. It is especially helpful in patients with negative results of sputum and bronchoscopic examinations.     

Use of the flexible fibreoptic bronchoscope in diagnosis of sputum-negative pulmonary tuberculosis

In four years' use of the flexible fibreoptic bronchoscope in diagnosing sputum-negative pulmonary tuberculosis, of 275 patients with tuberculosis suspected from chest radiographic appearances, 89 (32.4%) were shown to have active disease. In 60 (67.4%) of these patients the diagnosis was made from samples obtained through the fibreoptic bronchoscope (56 from bronchial brushings, four from transbronchial biopsy samples). Of the 56 positive bronchial brushings, 35 were positive on direct smear and 21 only on culture. Transbronchial biopsy exclusively accounted for only four of the 60 positive diagnoses. In the remaining 29 patients, the diagnosis was made from further sputum or biopsy specimens in 15, from the response to treatment in 12, and at necropsy in two. In six of 10 patients with military tuberculosis, bronchial brushings were positive on direct smear.     

The diagnostic yield of prebronchoscopy sputa and bronchial washings in patients with biopsy-proven pulmonary tuberculosis

We report on a series of 35 patients with pulmonary tuberculosis diagnosed by flexible fibre-optic bronchoscopy and transbronchial lung biopsy after 3 sputum specimens had been microscopy-negative. This study re-evaluates this invasive procedure. Additional prebronchoscopy specimens of expectorated sputum yielded the diagnosis in 7 of 16 cases (43.8%) on microscopy. Sputum culture results were positive in 12 of 33 (36.4%). Pleural fluid culture was diagnostic in 1 case, and in another miliary tuberculosis was demonstrated on bone marrow trephine biopsy. The availability of these results could therefore have obviated the need for bronchoscopy in 14 of the 35 patients (40%). Bronchial washings were positive for acid-fast bacilli on microscopic examination in 13 of 34 cases (38.2%) and culture-positive in only 18 of 34 (52.9%), and should therefore not be the sole procedure utilised when bronchoscopy is performed. Transbronchial lung biopsy remains a valuable procedure to confirm pulmonary tuberculosis in patients whose sputum is culture-negative for mycobacteria.     

Bronchoscopic evaluation of peripheral lung tumours.

The results obtained from fibreoptic bronchoscopy preformed under fluoroscopic guidance were evaluated in a prospective study of 71 consecutive patients with a peripheral lung lesion more than 2 cm in diameter on the chest radiograph. A peripheral lung lesion was defined as a lesion that was not seen within the bronchial tree at fibreoptic bronchoscopy. Small volume washings, bronchoalveolar lavage, transbronchial biopsy, and bronchial brushings were carried out and fluid or tissue was sent for cytological or histological examination as appropriate. Of the 71 patients, 51 were subsequently shown to have malignant disease. In 38 of the patients the diagnosis of malignancy was made by bronchoscopy, from histological specimens alone or in conjunction with cytological specimens in 33, from brushings alone in two, and from bronchoalveolar lavage fluid alone in three patients. There were no important complications. Thus fibreoptic bronchoscopy in conjunction with fluoroscopic screening appears to be an effective and safe method for the initial investigation of a peripheral lung lesion more than 2 cm in diameter.     

Value of washings and brushings at fibreoptic bronchoscopy in the diagnosis of lung cancer.

A retrospective study was performed to evaluate the diagnostic yield for lung cancer from histological biopsy specimens and from washings and brushings for cytological examination taken at fibreoptic bronchoscopy. The records of 680 bronchoscopies were analysed. Of 300 patients eventually diagnosed as having a malignant lesion, 188 had had biopsy, washing, and brushing. Of these, 125 had endoscopically visible tumour (group A) and 63 had no abnormal findings or abnormal findings that were not diagnostic of malignancy (group B). In group A biopsy specimens gave a positive result in 76% of cases, washings in 49.6%, and brushings in 52%; biopsy material gave the only positive result in 22.4% of cases, washings in 2.2%, and brushings in 4.8%. In group B biopsy specimens were positive in 36.5%, washings in 38.1%, and brushings in 28.6%; biopsy gave the only positive result in 11.1% of cases, washing in 9.5%, and brushing in 3.2%. Washing had a higher diagnostic yield than brushing in group B. Biopsy and cytological examination of either washings or brushings were found to give over 95% of all positive results in group A, but in group B the combination of biopsy and washing was more often successful (94.3%) than biopsy and brushing (82.8%). It is concluded that for the maximum diagnostic yield in the diagnosis of lung cancer biopsy should be combined with cytology using both washings and brushings.     

Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis

BACKGROUND: Previous studies suggest that bronchoscopy and a single induced sputum sample are equally effective for diagnosing pulmonary tuberculosis. METHODS: In a prospective study of subjects with possibly active pulmonary tuberculosis, the diagnostic yield of three induced sputum tests was compared with that of bronchoscopy. Subjects either produced no sputum or (acid fast) smear negative sputum. Bronchoscopy was only performed if at least two induced sputum samples were smear negative. RESULTS: Of 129 subjects who completed all tests, 27 (21%) had smear negative and culture positive specimens, 14 (52%) on bronchoscopy and 26 (96%) on induced sputum (p<0.005). One patient was culture positive on bronchoscopy alone compared with 13 on induced sputum alone; 13 were culture positive on both tests. Induced sputum positivity was strikingly more prevalent when chest radiographic appearances showed any features of active tuberculosis (20/63, 32%) than when appearances suggested inactivity (1/44, 2%; p<0.005). Induced sputum costs were about one third those of bronchoscopy, and the ratio of costs of the two tests per case of tuberculosis diagnosed could be as much as 1:6. CONCLUSIONS: In subjects investigated for possibly active or inactive tuberculosis who produce no sputum or have smear negative sputum, the most cost effective strategy is to perform three induced sputum tests without bronchoscopy. Induced sputum testing carries a high risk of nosocomial tuberculosis unless performed in respiratory isolation conditions. The cost benefits shown could be lost if risk management measures are not observed.     

Cytological sampling at fibreoptic bronchoscopy: comparison of catheter aspirates and brush biopsies.

A prospective study was undertaken to compare bronchial brushings with dry catheter aspiration for the cytological diagnosis of lung cancer at fibreoptic bronchoscopy. Duplicate samples taken by aspirate and brush were obtained at 103 consecutive routine bronchoscopies. Aspirate and brush samples were reported on separately by two cytologists. At the end of the study a 30% sample, including the 19 cases with different findings by the two methods, were subjected to a blind crossover review, and then an open review. Forceps biopsy specimens for routine histological assessment were taken in 94 cases (92%). Ninety-eight of 103 (95%) aspirates and 99 of 103 (96%) brush specimens were technically satisfactory. Carcinoma was diagnosed at bronchoscopy on cytological or histological evidence or both in 57 cases. Fifty-five of these tumours (96%) were recognised by either the aspirate or the brush method, 52 (91%) by brush, and 50 (88%) by aspirate. Thirty-four cases (60%) could be diagnosed from histological specimens. The order of cytological sampling did not systematically affect yield. It is concluded that fine-catheter aspirates, permitting smears to be prepared in the laboratory, are a satisfactory alternative to brush smears for the cytological diagnosis of lung cancer at bronchoscopy. The routine use of both techniques at bronchoscopy will increase diagnostic yield by about 5%. Duplicate sampling may be especially useful in obtaining diagnostic material from upper-lobe or apical-segment tumours.     

Role of fibreoptic bronchoscopy in the diagnosis of mycobacterial diseases.

From January 1976 to December 1981 mycobacteria were recovered for the first time from the respiratory tract of 179 patients. Twenty-three patients had undergone fibreoptic bronchoscopy during initial investigation after three or more expectorated sputum specimens were negative for acid-fast bacilli. Three of these patients had nodular lesions on the chest radiograph and the diagnosis of mycobacterial disease was made only after thoracotomy. In the remaining 20 patients bronchial brushings yielded a positive culture in 19, while bronchial brushing was negative in one patient in whom culture of sputum before bronchoscopy had been positive. In eight of these 19 patients (group A) bronchial brushing was the only source that gave a positive result from culture, while in 11 patients (group B) both bronchial brushing and prebronchoscopy sputum yielded positive cultures. When these two groups were compared no difference was seen in their clinical presentation or radiographic findings but there was a notable difference in the quality of the presentation or radiographic findings but there was a notable difference in the quality of the prebronchoscopy sputum. Six of eight patients in group A had poor prebronchoscopy sputum, while 10 of 11 in group B had good prebronchoscopy sputum. It is concluded that, if a patient is unable to produce sputum or is able to produce only a poor specimen, fibreoptic bronchoscopy may be a useful means of obtaining additional material for culture.     

Value of tissue biopsy in bone and joint tuberculosis

This study discusses the difficulties in making the diagnosis of bone and joint tuberculosis and underlines the diagnostic value of tissue biopsy from the site of the suspected tuberculosis lesion. Fifty-two patients, suffering from this disease, underwent treatment at our hospital between 1980-1986. In 27 cases (51%) the diagnosis was made on the basis of the clinical picture and various tests not including biopsy. The other 25 cases (48%) required a biopsy, and tissue specimens were sent for histological examination and culture with the L?wenstein-Jensen medium. In 9 (17.3%) patients the biopsy was performed early, while in another 16 (30.8%) patients there was a delay (23 months on average). From the total of 25 biopsies the histological examination showed findings compatible to tuberculosis in 23 (92%), while the culture of the same material was positive only in 10 (40%). The high rate of diagnostic accuracy with the biopsy, proves that this method is probably the most useful one for the diagnosis of bone and joint tuberculosis and emphasizes the need to use this method more often.     

Pancreatic tuberculosis

A 63-year-old Japanese man visited our institute with fever of unknown origin. Findings on preoperative imaging modalities were consistent with pancreatic carcinoma, but a positive tuberculin skin test indicated tuberculosis infection. Negative results for MycobacteriumDNA polymerase chain reaction from sputum and bone-marrow aspiration biopsy specimens ruled out pulmonary and miliary tuberculosis, respectively. Positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy- d-glucose (FDG) showed multiple labeled spots within the pancreas body and chest. Distal pancreatectomy was performed with a diagnosis of suspected pancreatic carcinoma, but the histological and microbiological diagnosis was Mycobacterium infection. A rare case of pancreatic tuberculosis evaluated by FDG PET is reported and discussed herein.     

Multiple brushings with immediate Riu's stain via flexible fibreoptic bronchoscopy without fluoroscopic guidance in the diagnosis of peripheral pulmonary tumours.

BACKGROUND--Accurate diagnosis of peripheral pulmonary lesions usually relies on fluoroscopic guided procedures. As fluoroscopy is not routinely available in many respiratory units, an approach not using fluoroscopy but with a high diagnostic yield is highly desirable. METHODS--Immediate cytological examination of multiple brushings using Riu's stain, a modified Wright's stain, was performed in 38 patients with peripheral pulmonary lesions not visible at bronchoscopy. The results were compared with the final diagnoses determined by histological examination or subsequent Papanicolaou staining of cytological specimens and clinical course. RESULTS--Of the 38 patients 29 were subsequently confirmed to have a malignant tumour. Our method provided a diagnosis of malignancy in 86% of these lesions. The accuracy (91%) and sensitivity (88%) were higher for lesions > 3 cm in diameter than for those of diameter < or = 3 cm (87% and 83%). There were no false positive results. The 29 lesions correctly diagnosed as malignant by Riu's stain required significantly fewer brushings (mean (SD) 3 (2)) than the nine benign lesions (5 (4)). CONCLUSIONS--This technique provides a high diagnostic yield, avoids the need for fluoroscopy, and is probably safer than percutaneous biopsy.     

The ligase chain reaction as a primary screening tool for the detection of culture positive tuberculosis

BACKGROUND: The ligase chain reaction Mycobacterium tuberculosis assay uses ligase chain reaction technology to detect tuberculous DNA sequences in clinical specimens. A study was undertaken to determine its sensitivity and specificity as a primary screening tool for the detection of culture positive tuberculosis. METHODS: The study was conducted on 2420 clinical specimens (sputum, bronchoalveolar lavage fluid, pleural fluid, urine) submitted for primary screening for Mycobacterium tuberculosis to a regional medical microbiology laboratory. Specimens were tested in parallel with smear, ligase chain reaction, and culture. RESULTS: Thirty nine patients had specimens testing positive by the ligase chain reaction assay. Thirty two patients had newly diagnosed tuberculosis, one had a tuberculosis relapse, three had tuberculosis (on antituberculous therapy when tested), and three had healed tuberculosis. In the newly diagnosed group specimens were smear positive in 21 cases (66%), ligase chain reaction positive in 30 cases (94%), and culture positive in 32 cases (100%). Using a positive culture to diagnose active tuberculosis, the ligase chain reaction assay had a sensitivity of 93.9%, a specificity of 99.8%, a positive predictive value of 83.8%, and a negative predictive value of 99.9%. CONCLUSIONS: This study is the largest clinical trial to date to report the efficacy of the ligase chain reaction as a primary screening tool to detect Mycobacterium tuberculosis infection. The authors conclude that ligase chain reaction is a useful primary screening test for tuberculosis, offering speed and discrimination in the early stages of diagnosis and complementing traditional smear and culture techniques.     

Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients

In this prospective study of 240 black patients with liver enlargement admitted to the medical wards of King Edward VIII Hospital, Durban, a cause for the hepatomegaly was found in 92.5% of cases (63.8% without recourse to biopsy, 28.7% after liver biopsy). The commonest cause was congestive heart failure (36.7%), followed by amoebic liver abscess (7.1%), hepatocellular carcinoma (5.8%) and cirrhosis (5.4%). Liver biopsy provided the diagnosis in 90.8% of patients with initial unexplained hepatomegaly. The diagnostic yield of liver biopsy was increased by submitting 3 biopsy specimens for histological examination. The 3 specimens are obtained using a single intercostal entry site and redirecting the biopsy needle, without increasing the risk of complications. Hepatic tuberculosis was present in 9.2% of patients who underwent biopsy. There were no consistent clinical findings in these patients. Therefore, in communities in which tuberculosis is endemic, all patients with unexplained hepatomegaly require liver biopsy since it provides the only means of making this diagnosis.     

Autopsy case of miliary tuberculosis with cerebral involvement in renal failure

We encountered an autopsy case of renal failure complicated by cerebral tuberculosis. The patient was hospitalized due to disturbance of consciousness, and dialysis therapy was performed because of end-stage renal failure. Approximately 1 week later, abnormal shadows were observed on chest X-ray, and various examinations were performed until the diagnosis was finally determined as miliary tuberculosis. Disturbance of consciousness was exacerbated, despite the administration of antituberculosis drugs and other treatments, and the patient died on the 105th hospital day. Pathological examinations demonstrated miliary tuberculosis associated with intracranial involvement, in addition to contracted kidneys. In patients with end-stage renal failure, the risk of developing tuberculosis, miliary tuberculosis in particular, is reported to be much higher than in normal subjects. However, the diagnosis of miliary tuberculosis is difficult to establish, because of nonspecific symptoms and the low rate of detection of acid-fast bacteria from the sputum. Comprehensive understanding of the results of frequent culture examinations of sputum and blood, contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), and Polymerase chain reaction (PCR) of cerebrospinal fluid, as well as albumin concentration in the cerebrospinal fluid, are considered useful in diagnosing intracranial tuberculosis. Although cerebral tuberculoma is rare, prolonged disturbance of consciousness may be related to cerebral tuberculosis. Therefore, particular attention should be paid to patients with end-stage renal failure complicated by disturbance of consciousness. Received: October 9, 1998 / Accepted: February 23, 1999     

Thoracic lymphadenopathy in Asians resident in the United Kingdom: role of mediastinoscopy in initial diagnosis.

Although the incidence of superficial glandular tuberculosis is high in Asian immigrants, a clinical diagnosis without biopsy has previously been shown to be inaccurate in 22% of cases. The role of diagnostic mediastinoscopy and biopsy in thoracic lymphadenopathy was therefore evaluated in 41 consecutive Asian patients. Tuberculosis was diagnosed by histological examination or culture (or both) of gland biopsy material in 24 (59%). A further 12 patients, however, also received antituberculous chemotherapy, with a response in 10 cases. If these are included, 34 (83%) were finally considered to have tuberculosis. The symptoms and ages of the patients with tuberculosis were similar to those typically seen in caucasians with sarcoidosis. Six had tuberculous bilateral hilar lymphadenopathy. In only four cases (10%) was a positive diagnosis other than tuberculosis established; in two (lymphoma and thymoma) mediastinoscopy confirmed preoperative suspicions, and saved only two more (with sarcoidosis and vascular anomaly) from unnecessary antituberculous treatment. Complications included severe haemorrhage (1) and chronic tuberculous sinus in the endoscopy tract (2). Mediastinoscopy is unlikely to change management in most patients, produces an appreciable amount of morbidity, and should be reserved for cases in which there is additional clinical doubt. Any future decline in the prevalence of tuberculosis in Asians may, however, require its further evaluation.     

Diagnosis of lung cancer by fibreoptic bronchoscopy: problems in the histological classification of non-small cell carcinomas.

Specific cell typing in lung cancer has important implications for assessment of prognosis and the planning of treatment. Cell typing is, however, often difficult and the problem has been compounded by the universal use of the flexible fibreoptic bronchoscope, which yields specimens only 2 mm in diameter. We have reviewed the records of 107 patients who had a diagnosis of lung cancer established by fibreoptic bronchoscopy and who subsequently underwent staging biopsy or surgical resection. Examination of tissue obtained by surgical resection yielded a different cell type from that identified in specimens obtained at fibreoptic bronchoscopy in 11 of 32 patients with a bronchial biopsy specimen diagnostic of squamous cell, three of 44 patients with a diagnosis of adenocarcinoma, six of seven thought to have a poorly differentiated carcinoma, and 21 of 24 patients with a diagnosis of large cell carcinoma. In all, 41 of the 107 surgically removed specimens (38%) differed in cell type from their corresponding bronchoscopic specimens. Accurate cell typing by specimens obtained at fibreoptic bronchoscopy may be extremely difficult. If clearcut morphological criteria cannot be satisfied, the diagnosis of "lung cancer, non-small cell type" should be made.     

Mycobacterial isolations in young adults with cystic fibrosis.

In 223 patients admitted to hospital with cystic fibrosis mycobacteria were found in the sputa of seven. All of these cases were identified over a six year period after the introduction of routine examination and culture of sputum for acid fast bacilli in patients with cystic fibrosis. The organisms isolated were Mycobacterium tuberculosis in three patients, M chelonei in one, M fortuitum in one, and unidentified mycobacteria in two. The diagnosis was not suspected on clinical grounds in any of the cases; in one patient, however, night sweats were a prominent feature before diagnosis. In four of the patients direct sputum smear examination did not reveal the organism, which was grown subsequently in culture. An unusual phenomenon of liquefaction of the Lowenstein-Jensen culture medium was encountered in five of the seven patients described, which in one case made identification and sensitivity testing of the organism impossible. This phenomenon has been observed in sputum cultures from other patients with cystic fibrosis but not in other pulmonary diseases. Immunological studies performed in three of the patients showed normal numbers of peripheral blood T and B lymphocyte in all three; in vitro lymphocyte transformation to tuberculin PPD was, however, reduced in the patient with extensive M fortuitum infection, which proved fatal. Mycobacteria may be present in the sputa of patients with cystic fibrosis more often than previously recognised and therefore sputum examination and culture for mycobacteria should be performed periodically in these patients.     

Diagnosis of upper gastro-intestinal lesions by endoscopy, cytology and biopsy.

A prospective consecutive series of 210 upper gastrointestinal endoscopic procedures, at which material for both cytological and histopathological examination was obtained, was conducted at Baragwanath Hospital. The purpose of the study was to determine the respective and combined diagnostic value of endoscopic visualization, cytological brushings and histological sections in benign and malignant lesions of the oesophagus and stomach; and in particular to assess the contribution, if any, of exfoliative cytology to the diagnostic regimen. Endoscopic visualization alone was inconclusive or incorrect in 13% of procedures, cytology alone in 9%, and biopsy alone in 12% (the latter 2 figures corrected for adequacy of material submitted). When assessed together, the diagnostic accuracy achieved by all 3 techniques was 99%. The major contribution of cytology was the correct positive diagnosis in 20% of procedures, performed on patients with malignant lesions, whose initial biopsy specimen was inadequate or normal. It is concluded that for maximal diagnostic accuracy of upper gastro-intestinal lesions, a combined approach, utilizing endoscopic examination, lesion-directed brushings and biopsy specimens, is required.     

Notification of tuberculosis: how many cases are never reported?

BACKGROUND: Notification of tuberculosis is essential for local contact tracing and for assessing the national incidence of tuberculosis. The accuracy of notification figures is uncertain. This study examined the notification rates of all patients diagnosed as having tuberculosis at two hospitals in the East End of London over five years. METHODS: In a retrospective survey of all patients aged 16 years or more presenting with tuberculosis to the London Chest Hospital or the Royal London Hospital from 1 January 1985 to 31 December 1989, cases of tuberculosis were identified from microbiology and histology records, statutory notifications, necropsy reports, coroners' records, hospital activity data, and death certificates. Clinical data were obtained from case notes and notification was determined from the local authority notification lists. RESULTS: Six hundred and nine adult patients with tuberculosis were identified. Notes were available for 580 cases (95%), of which 426 (73%) had been notified. The proportion of cases notified varied according to the specialty of the clinician in charge of the patient at diagnosis. Patients with a past history of tuberculosis and those who died within one year were less likely to have had their tuberculosis notified. Age, race, and lack of microbial or histological confirmation of diagnosis did not influence the proportion of cases notified. One hundred and eighty five patients had smear positive sputum, but 25 of these cases (14%) were not notified. Eighty five patients who had presented with pulmonary tuberculosis did not have their disease notified; 20 (24%) had smear positive sputum. CONCLUSIONS: Many cases of tuberculosis are not notified (27%). Fourteen per cent of all sputum smear positive cases of tuberculosis were not notified, and these patients are a considerable public health risk. The true incidence of tuberculosis in the area studied is at least one third higher than current notification figures suggest.     

超声支气管镜引导下的经支气管针吸活检术诊断菌阴肺结核

目的 探讨超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)诊断细菌培养阴肺结核的有效性.方法 对于3次常规结核杆菌痰检阴性、伴肺门和(或)纵隔淋巴结肿大临床疑似肺结核的患者随机分为2组,比较支气管肺泡灌洗组即BAL组(对照组)和EBUS+ BAL组(试验组)诊断菌阴肺结核的差异.结果筛选115例患者,其中82例患者进入该研究,对照组40例,试验组42例.对照组通过细菌学明确诊断8例,诊断性抗结核治疗后明确诊断27例,手术证实非结核诊断5例;试验组通过细菌学和病理学明确诊断28例,假阴性8例,其他诊断6例.EBUS+BAL组诊断敏感性为77.8％,显著高于BAL组的22.9％ (x2 =21.4,P＜0.01);EBUS+BAL组阴性预测值也显著高于BAL组(42.9％对15.6％,x2=3.97,P=0.046).两组间并发症相似,仅1例试验组穿刺点出血需要止血干预.结论 EBUS-TBNA对菌阴肺结核伴肺门和(或)纵隔淋巴结肿大的患者诊断敏感性和阴性预测值高,并发症少,将成为菌阴肺结核患者一种新的诊断方式.